Objective: We aimed to compare the effects of two different opioids, fentanyl and remifentanil with shortacting inhalation agent, desflurane on intraoperative hemodynamics and recovery quality in the postoperative period in anesthesia for day case surgery. Methods: A prospective randomized case control study was carried out at Anesthesia and Reanimation Clinics of The Istanbul Education and Research Hospital with the approval of the local ethics committee between 2001-2002. The study population (n=100) who has arthroscopic knee surgery was composed of patients between the ages of 18-65 classified as ASAI-II. The cases were randomized and divided into two groups. After giving fentanyl to patients in the first group and remifentanil infusion to patients in the second group, induction has administered by propofol and mivacurium was given as a muscle relaxant in both groups. After endotracheal intubation, systemic blood pressure, heart rate and peripheral oxygen saturation (SpO2) values were recorded every five minutes. When the surgery was completed, eye opening, following commands, saying her name, saying her birthday, sitting without help and getting the correct answer to the DSS test was recorded for both groups. Visual Pain Scale (VAS) and Modified Aldrete Score were evaluated and recorded at 0, 15, 30, and 60 minutes. Patients were observed and recorded in terms of side effects such as increased secretion, bradycardia, nausea, vomiting, dizziness, headache, and tremors in both groups. Results: In terms of demographic features there was no statistically significant difference between the two groups. Generally, systemic blood pressures were significantly higher in the fentanyl group. Heart rate was significantly higher in fentanyl group during intubation and intraoperative periods. There was no statistically significant difference between groups in terms of Sp02. Time until spontaneous breathing, extubating, eye opening, following commands, saying the name, DSST and unassisted sitting were significantly longer in the fentanyl group. The mean values of VAS scores at the 15th and 30th minutes were significantly higher in the remifentanil group. Similarly, the mean Aldrete recovery scale scores at 15th and 30th minutes were significantly higher in the remifentanil group. When postoperative pathological findings were evaluated, the frequency of bradycardia was significantly higher in the remifentanil group, there was no difference in terms of other side effects. Conclusion According to the our study results; we concluded that it is a better alternative to use remifentanil together with desflurane which is preferred short-acting inhalation agent in ambulatory anesthesia; in terms of hemodynamic stability during the intubation, peroperative and extubation periods and rapid postoperative recovery.

Hydatid cysts are parasitic infections caused by echinococcus granulosus and echinococcus alveolaris. These infections are characterized by cystic formations most commonly localized in the liver and lungs. These cysts demonstrate widespread hepatic, and pulmonary involvement. Rupture of the cyst due to trauma, spontaneously or during surgical intervention may lead to anaphylactic shock or even death. During hydatid cyst operations, suddenly developing desaturation, tachycardia and hypotension should lead to the consideration of anaphylaxis. These complications should remind us that patients being operated for hydatid cysts may develop anaphylaxis and preparations should be made for this complication, and dialogue with the surgical team may reduce mortality and morbidity rates. In this case report we present a patient undergoing surgical excision of hepatic hydatid cyst who developed anaphylactic shock and resulting cardiac arrest due to rupture of the cyst and traumatization of the hepatic vein.

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